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Have you joined our BOTOX CLUB yet?

OUR BOTOX CLUB IS HANDS-DOWN THE BEST WAY TO SAVE HUNDREDS ON BOTOX IF YOU RECEIVE REGULAR SESSIONS.

When you become a member of our exclusive club, you’ll get to enjoy discounts on Botox all year long!

BOTOX CLUB ORIGINAL

Botox at $16.50/unit
(40 units, 4 x per year)

$2640
INCLUDES A $50 VOUCHER
TOWARD ANY FACIAL

GLOWTOX CLUB

Botox at $14.00/unit
(40 units, 4 x per year) + series of 3 VI peels

$3065
INCLUDES A $100 VOUCHER
TOWARD ANY FACIAL SERVICE + 15% OFF FACIAL PRODUCTS ALL YEAR LONG

WELCOME TO OUR BOTOX CLUB!

As a member, you receive special pricing for Botox all year! Plus one complimentary facial a year.
The following lists the terms of conditions of our Botox Club. Please read carefully and initial at each line, and feel free to ask any questions.

– I understand that NO REFUNDS or services beyond contract dates are allowed under any circumstance.
– I understand that my membership benefits CANNOT be shared, and do not accrue. Discounts and facial are non-transferrable, and facial does not “roll over” to the following year if unused. I must use the units purchased in a 12 month period.
(Requires a minimum of 40 units per tx.)

By signing below, I indicate understanding of the Botox Club benefits, and the terms and conditions that apply. In addition, I hereby authorize Deborah Longwill DO PA to charge the card listed below for the membership fee.

rostro

Botox Consent Form

Please fill out the Botox Membership & Authorization Consent Form

Patient Name(Required)
MM slash DD slash YYYY
MM slash DD slash YYYY
Reset signature Signature locked. Reset to sign again
MM slash DD slash YYYY

Have you joined our BOTOX CLUB yet?

OUR BOTOX CLUB IS HANDS-DOWN THE BEST WAY TO SAVE HUNDREDS ON BOTOX IF YOU RECEIVE REGULAR SESSIONS.

When you become a member of our exclusive club, you’ll get to enjoy discounts on Botox all year long!

BOTOX CLUB ORIGINAL

Botox at $16.50/unit
(40 units, 4 x per year)

$2640
INCLUDES A $50 VOUCHER
TOWARD ANY FACIAL

GLOWTOX CLUB

Botox at $14.00/unit
(40 units, 4 x per year) + series of 3 VI peels

$3065
INCLUDES A $100 VOUCHER
TOWARD ANY FACIAL SERVICE + 15% OFF FACIAL PRODUCTS ALL YEAR LONG

WELCOME TO OUR BOTOX CLUB!

As a member, you receive special pricing for Botox all year! Plus one complimentary facial a year.
The following lists the terms of conditions of our Botox Club. Please read carefully and initial at each line, and feel free to ask any questions.

– I understand that NO REFUNDS or services beyond contract dates are allowed under any circumstance.
– I understand that my membership benefits CANNOT be shared, and do not accrue. Discounts and facial are non-transferrable, and facial does not “roll over” to the following year if unused. I must use the units purchased in a 12 month period.
(Requires a minimum of 40 units per tx.)

By signing below, I indicate understanding of the Botox Club benefits, and the terms and conditions that apply. In addition, I hereby authorize Deborah Longwill DO PA to charge the card listed below for the membership fee.

rostro

Botox Consent Form

Please fill out the Botox Membership & Authorization Consent Form

Patient Name(Required)
MM slash DD slash YYYY
MM slash DD slash YYYY
Reset signature Signature locked. Reset to sign again
MM slash DD slash YYYY

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